LIVE 2021 Middle school Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

Spot Guaranteed Due to Payment Held from last Summer *

YES

Camper Info

Sponsored Member of New York Road Runners? *

Yes

Camper's First Name *

Camper's Last Name *

Camper's E-mail *

Gender *

Male

Female

Address

Street *

City *

State *

Zip Code *

Parent/Guardian Name *

Parent/Guardian E-mail *

Home Phone # *

Parent Cell Phone # *

Parent Work Phone # *

Emergency Contact Name *

Emergency Contact Phone # *

School Info

Coach Name

Coach E-mail

Grade Entering *

School *

Training Info

Estimated Average Summer Running *

Please estimate the number of miles or amount of time you spend running each week during the summer.

Running Bio *

Below please describe your experience with running. Please include (if applicable) personal bests, number of years run, and anythings else you believe is pertinent.

Roommate Request (We will do our best to accommodate your request)

How did you learn about us? *

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms